Provider Demographics
NPI:1013991058
Name:SMITH, ERIC E (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:NEUROLOGY ASSOCIATES WAC 835
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-4484
Practice Address - Fax:617-726-0683
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA2136522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0169421Medicaid
MAJ24731OtherBCBS MA
MA734494OtherTUFTS HEALTH PLAN
H59973Medicare UPIN
MAJ24731OtherBCBS MA